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Home My WebLink About1127 IYANNOUGH ROAD/RTE132 - HAZMAT i��,� It�G�.V�n�� I3Z� � n►'s 027`� � �� 0 Number Fee 1113 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that HOLIDAYINN .-------------------------------------------------------------------------------------------------------------------------------- 1127 IYANNOUGH ROAD, HYANNI, MA ....-------------------------------------------------------------------------------------------------------------------------------------------------------------------- Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. ------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ Restrictions: -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. ---------------------------------------- JOHN NORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN,R.S.,CHO Director of Public Health Town of Barnstable Inspectional Services BARNSTABLE Q, Public Health Division , �SSWi54:i15.639-Rt_.1;.5'f B?C115'f4&E • 1639-3014 � LE. = Thomas McKean,Director , 'O�FD Wlpr a` 200 Main Street, Hyannis,MA 02601 >w"a C..? Office: 508-862-4644 Fax: 508-790-6304 as APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE `71 HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES . CATEGORY 1 PERMIT 26— 110 Gallons:- -- $-50.00 ❑- CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ®`VST- CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10 00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. a?'I.3' 0 0 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONLN- GBUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: Al 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: wl • 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: Nord1 8. TELEPHONE NUMBER OF ESTABLISHMENT: 5O�'�?S�tIS3 9. EMAIL ADDRESS: l.[/�b �� •�' ' 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD S�AND TEL PH NE# F: CORPORATION NAME • PRESIDENT lr$ �! TREASURER CLERK A&M hof tAk% 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: - • ATE SIGNATURE OF ArrLICANT C�G(� s Q:\Application Forms\Haz Mat Appli Draft Jan20l9.docx `°F� ►oy� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARNSTABLE. - MASS. g 200 Main Street• Hyannis, MA 02601 - "TFDMP TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: . I Date: 01 1 R"e, Location/Mailing Address: 1146 Tqwripuckh M wafttA, 0-1601 Contact Name/Phone: 1�14-1 r 7378 Inventory Total Amount: MSDS: License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator:� Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: Waste Product: Date&Amount of Last Shipment/FrequeM: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS n® ih �NOTE: Under the provisions of Ch. 111, Section 31, of the en I Laws oV material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: a Inspector- Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS view IKE roMti ®` Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 BARMA,S. ' 200 Main Street• Hyannis, MA 02601 059. ATFOMP'�a`0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: f plk'&H 1Y1Y1 Date: 1/9 Location/Mailing Address: aU Contact Name/Phone: 7 — I6 Inventory Total Amount: CSDS:_A S License#: Tier II : Labeling: Spill Plan: S Oil/WaterSeparator: Floor Drains: & — Mcd Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: 5 0 or Waste Generator ID: Waste Product: r I� Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) —�� Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives (creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners /Miscellaneous Combustible aint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers �PCB's Metal polishes Other chlorinated hydrocarbons Z Laundry soil &stain removers (including carbon tetrachloride) (including bleach) ab Any other products with "poison labels" i (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: U ` n� `C7y[S Inspector: Facility Representative: O WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 1113 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that HOLIDAYINN 112 7 IYANNOUGH ROAD, HYANNI, MA Is Hereby Granted a License For: Storing or Handling 111 -499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2020 unless sooner suspended or revoked. -------------------------------- PAUL J.CANNIFF, D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health yp Town of Barnstable A WE Inspectional Services BABSTABLE w r Public Health Division 5rneE. «,.1- R.. w,_ �a OSiCki u1;15.G^SY:LLE-'r�S'T BWvSitb:f Q li]9�-72f114 �' w RARNSTABLE. ''� MASS Thomas McKean, Director i639. ArEo ,,�a 200 Main Street, Hyannis,MA 02601 �1 all Office: 508-862-4644 Fax: 508-790-6304 . APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS 1N ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 168, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 X V6V CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. L0�"ZO 1. ASSESSOR'S MAP AND PARCEL NO. c r1 3 2. IS THIS A PERMIT RENEWAL? '-A,YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: tiC,g�J G 5. NAME OF ESTABLISHMENT: AD 1�6 A inn 6. ADDRESS OF ESTABLISHMENT: _ I-c1(lt`5r 1��I �� /� 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: o?Qq i S 8. TELEPHONE NUMBER OF ESTABLISHMENT: -tg;k-Y776-1 9. EMAIL ADDRESS: U lwp -Mx 10. SOLEOWNER: K YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME W ram, P-9 Gt VA p, W!, P i T Sdc. si ��yYns�G�i� TREASURER K CLERK "a 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\Haz Mat App Revised 09-10-18.docx Number Fee 1113 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that HOLIDAYINN 112 7 IYANNOUGH ROAD, HYANNI, MA Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. ---------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- --------------------------------------------------------- ------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health �toewgulatory Servvic s l p li Director � Richard V. Sca , ector ��7 ' Public Health Division BARNSTABLE 1z�r SAMRMLY Thomas McKean,Director 1639-w. -Mg � Mass g � //�'il -- -- —-- - —- - -- - - - 7 ----l./�---- - -i639- ♦Q' �G� Ar fo�b 2001VIain Street,-Hyarints-MA 02Ci01-- ---- -- ----— Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 1 st—JUNE 30th).8 APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 WV.5 CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. � 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES, SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 4-t c of l,�uoc�_ aA ( u_p s L.L c, 5. NAME OF ESTABLISHMENT: �a_k , oe1) 6. ADDRESS OF ESTABLISHMENT: kt ,e, C=Dwk 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 10. SOLEOWNER: YC YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD SS AND TELEP MW OF: l CORPORATION NAME PRESIDENT eC ') �r �` TREASURER VL1O_ CLERK n A- 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE Q:\Application Forms\HAZMAT APP 2017 REVISED.docx t °Eta*opti ! Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BA MA3,gBLE.�` 200 Main Street• Hyannis, MA 02601 " ,bM a,0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rf0 MA'S Business Name: (+0 n� —CWVk, Date: Location/Mailing Address: - 14 c+-A A.KA L Contact Name/Phone: V2 el, V6-c.o o --7 ( I ( ( So -72A.- GUZ Inventory Total Amount: SDS: License#: Tier II : Labeling: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar 'Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) -- V,I" S: &I, v1 J -a I I I A&4 `L 1 o ow h r t e N t.Q,vL 3 . ORDERS: C11-111V 1n ��Ovt C f wa 5 ✓�• DKo� INFORMATION/R OMMENDATIONS: 1 D V K(,�--,T ► A-p— ,-Z V4104k Inspecto . Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS i IKE�ogti u Town of Barnstable Office:508-862-4644 Public Health-Division Fax:508-790-6304 BA MASS.LE.� 200 Main Street• Hyannis, MA 02601 1639. 'prED M 6. TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: 14o 1, b,Qr�.l 7C-vt +A_ Date: S-/z5�/(nn Location/Mailing Address: I t�2"1 " G �, �. It r- µ V, S P ` Contact Name/Phone: Inventory Total Amount: SDS: License#: Tier II : Labelino: Spill Plan: Oil/WaterSeparator: Floor Drains: Emergency Numbers: 'Storage Areas/Tanks: Emergency/Containment Equipment: Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS ' NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid,other acids) VIOLATIONS: lqv G - yS� f,\J4, �V V41 01vr. �u tr ORDERS: C' , 11 ' a.n4% IA(io x J,, �',.. . oo- ��ak ln,�, nvt o C�w WAS -A- 104ow4L INFORMATION/RECOMMENDATIONS:'1 D Inspector-: ' L 1•P Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS -S Number Fee 1113 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that HOLIDAYINN 1127IYANNOUGH ROAD, HYANNI, MA \� Is Hereby Granted a License For: Storing or Handling 111 - 499 gallons of Hazardous Materials. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to,and and expires 06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health TRpwn of B�nstable pd eg atory ervlces Richard V. Scali, Director THE� Public Health Division BARNS LE ■ARNWABLE. • 8n"NST411tF•ZxfENVILLk•CQNIi•"Y4F(:IS Thomas McKean Directors" .�,Ea" �� ) 1639-2014 'Arfo s`� 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 � ^" Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT°HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 3 Oth). ` APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 ❑ *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. d-73 2. IS THIS A PERMIT RENEWAL?\K,YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS;INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: lCklT 5. NAME OF ESTABLISHMENT: tu VL�414D 6. ADDRESS OF ESTABLISHMENT: plA- 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: S. TELEPHONE NUMBER-OF ESTABLISHMENT: 9. , EMAIL ADDRESS: 10. SOLEOWNER:RYES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADD SS,AND TE EP O #OF: CORPORATION NAME L L PRESIDENT . WC-1 TREASURER j3 lQ CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS MAIL: SIGNATURE OF APPLICANT DATE Q:1Application Fonns\HAZMAT APP 2017 REV docx Il— I f IKE Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 snRMST�RLE.g• 200 Main Street• Hyannis, MA 02601 �°rFOMP+°`0 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: tlol,daW.I Date: 1 ba /b Location/Mailing Address: i 12-1 Kv%& 44k, &,10+s Contact Name/Phone: R11 r_L, 'Ne i o S68—?'7 S—11 3 GP l/ Sob—72(6— Inventory Total mount: MSDS: 25 k S License#: Z Tier II : o Labeling: l9 Spill Plan: L4 ds- ,54� Oil/WaterSeparator: 01A Floor Drains: �o Emergency Numbers: Storage Areas/Thnks: 4^C Emer enc /Containment E uipent: Waste Generator ID: N Waste Product: A Date&Amount of Last S ipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: K LIST OF TOXIC AND HAZARDOUS MATERIALS NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid �O— Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers n,ypc�� IG�}cln�►ti Hydraulic fluid (including brake fluid) Windshield wash Gl2ArwC Motor oils Miscellaneous Corrosives to to v►^�Qiwl- Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene,#2 heating oil Disinfectants Tot, tip-I��cs Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for•engines&garages Pesticides: lb Caulk/Grout 1 3 insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries"�,-... Photochemicals(Fixers) Rustproofers a °'"' w _ (Developer) Photochemicals Car wash detergents Printing ink Car waxes and polishes D Wood preservatives(creosote) Asphalt&roofing tar pbSwimming pool chlorine 30 Paints, varnishes, stains, dyes loo k Lye or caustic soda 3O' Lacquer thinners ( Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes �r CA- )t Miscellaneous Flammables S Aa Fertilizers Floor&furniture strippers ►%A-4 3� PCB's XZ Metal polishes , p� Other chlorinated hydrocarbons LOB Laundry soil &stain removers � �k (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: Dg i!,a 5 " ��-t� a v►�t q k-f2�4�� Inspector: I �t��-e Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS IME rti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 „ ABLE.�,' 200 Main Street• Hyannis, MA 02601 t639. MPS TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 Business Name: v', ►q,v%.-_ VetK,*t►5 1 A Date: VZ i 5- Location/Mailing Address: 117-3 Pya rt✓t►S — A" S `}�a Contact Name/Phone: e e a - -l►S Inventory Total Amount: a�zGs MSDS: 9- 5 License#: I � Tier II : Labeling: A*w-ZLerg, ill Plan: i1 VQ, ok5 Oil/WaterSeparator: Floor Drains:�e5 7 � ncy Numbers: Storage Areas/Tanks: 2 30 a ti <o�-5 o,( n c,4 4 e- m , k'v vo 1 Emergency/Containment E ui ment: 410, P1 $orb PC Waste Generator ID: Waste Product: Date&Amount of Last S ipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: A' .9 Z vp LIST OF TOXIC AND HAZARDOUS MATERIALS N 0 V^ti- \oirnofA, g �u- ��Aa<}� 3(v.c� NOTE: Under the provisions of Ch. 111-, Section 31, of the General Law hazardous material use, `erg ` 1O1 storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid If& Other cleaning solvents&spof_�e y vers�x ejp,�� Engine and radiator flushes Bug and tar removers 'mot Hydraulic fluid (including brake fluid Windshield wash ee,pr �I Motor oils Miscellaneous Corrosives 4 4 3oQ4-� Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar 6o� Swimming pool chlorine�o eIA4 f Sb b 1 30 g04 Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil&stain removers y�x (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: 9Z<YVA 'OL-1-b-le-tt ORD RS: Q � 2c %4-u - c a< vt.5 � ate. INFORMATIO /RECOMMENDATIONS: ve],A.�c (L&- \a-\)KAf ro Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS °F1HE r Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RARMASS . . • 200 Main Street• Hyannis, MA 02601 Fo39.+6 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: o l,4y73:�w �1 / S Date: //II� a K Y1 (� Location/Mailing Address: i�27 �<K�� Contact Name/Phone: 5-a8- -7-75- 115-3 -72(o-Io 112 Inventory Total Amount: ^'� MSDS: qe5 License#: I 1 13 Tier II : O Labeling: 0Y"- Spill Plan: �e- Oil/Water Separator: Floor Drains: 0 o Emergency Numbers: �-s Storage Areas/Tanks: Ael Emer enc /Containmen E ui ment: -5, 0 Waste Generator ID: NNA -� Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS �o ,M a�1of c-`nA �� •`� �Co< V AV\.c..e- la.tk t%k-lRQrX�ow NOTE: Under the provisions of Ch. 111, Section 31, of the&neral LaYivs of MA, hazardous material use, storage and disposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils �— Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil �— Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes �— Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons �— Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INffF,,ORMATION/RECOMMENDATIONS: C e.V- ,74 $KA Qgso&ik !!44N-u6-k JP �\ k Inspector I ` Facility Representative: WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS Number Fee 1113 THE COMMONWEALTH OF MASSACHUSETTS 1oo.0o Town of Barnstable Board of Health This is to Certify that HOLIDAYINN 1127 IYANNOUGH ROAD, HYANNI, MA Is Hereby Granted a License FOR: STORING OR HANDLING 111 GALLONS OR MORE OF HAZARDOUS MATERIALS. -------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances.relating there to, and \ and expires 06/30/2016 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/2015 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO - Director of Public Health C� 1r' ' �•9 Town of Barnstable °FIHE r Regulator Services Richard V. Scali, Director �'" A E MSS. g Phblic.Health Division MASS. t63q. l�D r nea1 . Thomas McKean, Director 200 Main Street, Hyannis,,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Application Fee: $100.00 ASSESSORS MAP AND PARCEL NO. 2-7 3 &-'Q DATE -2 2- APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE MORE THAN I II GALLONS OF HAZARDOUS MATERIALS FULL NAME OF APPLICANT R t Jge,,)opJ NAME OF ESTABLISHMENT I-I b i d•-,� Cn� ADDRESS OF ESTABLISHMENT I L'7 •iaA*'*iorr.�� J,�i�„� (� /AA •, TELEPHONE NUMBER 7 .5-" 1 1 5 3 SOLE OWNER: " YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: /V A _ L L C- 01 a )f rTr"I C_y p 0 /A IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. 210 2-6 Z l 5'h STATE OF INCORPORATION MA FULL NAME AND HOME ADDRESS OF: PRESIDENT s,�� Z 9 7 Ndd ll ; jot/G A1►i, , /44,4 6 0 1 TREASURER CLERK SIGNATURE OF APPLICANT RE'STRICTI®NS: HOME ADDRESS 14 z .5 ,A HOME TELEPHONE# 570 E' 7 7-- J 16 Q:\Application Forms\HAZAPP.DOC ar ro Town of Barnstable office: 508-862-4644 o Regulatory Services Department Fax: 508-790-6304 snx�N3rn� Public Health Division v MASS. Thomas A. McKean,CHO $"rFQ MAC ` 200 Main Street, Hyannis, MA 02601 Payment Receipt ;Hazardous Materials Payment received: $110.00 (Check) on 7/29/2015 ICheck number: 11469 Check amount: $110.00 Name on check: Ridgewood Hotel Group, LLC Business: Holiday Inn Owner: SLEEPY TIME LLC Address: 1127 IYANNOUGH ROAD/RTE132, Hyannis Note: $100 + $10 late fee • Number Fee 1113 THE COMMONWEALTH OF MASSACHUSETTS $125.00 Town of Barnstable Board of Health This is to Certify that HOLIDAY INN 112 7 IYANNO UGH ROAD, HYANNI, MA Is Hereby Granted a License For: Storingor Handling 111 - 499 gallons of Hazardous Materials. 9 ---------------------------------------------------------------------- -------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and (� and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. _ 07/01/2016 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health i JUN 0 6 2016 Town of Barnstable Regulatory Services c. Richard V. Sca1i,Director z Public wealth Division B TABLE Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 ( (�� ►+ Office: 508-862-4644 Fax: 508-790-6304 N APPLICATION FOR PERMIT TO STORE AND/OR UTELIZE HAZARDOUS MATERIALS IN ACCORDANCE.WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS DULY 1 st TUNE 30th). APPLICATION FEES CATEGORY 1'PERNIIT 26= 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 � CATEGORY.3 PERMIT 500 or more Gallons:$150.00. ❑ A late charge of$10 00 will be assessed if Rayment is not received by July.1st. ASSESSORS MAP AND PARCEL NO. 2 7 3/8 0 . DATE June .8., 2016 FULL NAME OF APPLICANT: Ridgewood Hotel Group, L L C NAME OF ESTABLISHMENT• Holiday I n n ADDRESS OF ESTABLISHMENT: 11'2 7 I y.a n n o u g h R d. ,. Hyannis , MA 02601 MAILING ADDRESS(IF DIFFERENT): 297 North St. , Hyannis , MA 02601 TELEPIONE:NUMBER OF.ES.TABLISW WENT: 5.0 8-7 7 5-115 3 L ____ EMAILADDRESS: tbusby@hollymanagement. com SOLE OWNER: X YES—NO IF NO,NAME OF PARTNER: FULL NAME;HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME Ridgewood Hotel Group, LLC Stuart. Bornstein , SOC Signatory. . . PRESIDENT. . TREASURER n/a CLERK n/a IF.PREPARED BY OUTSIDE PARTY: SIGNATURE OF AP Iv'T Name*.,. Company Address : Telephone#: Email: Q:\Applicauon formsUiAZZAPP Revl6.docx Page 1 of 2 Date: 1// 13113 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: o , —V1 yx yi BUSINESS LOCATION: 119-7 �'ya,� ovg �.. t�� ay4yl✓t i s INVENTORY MAILING ADDRESS: S4 TOTAL AMOUNT- TELEPHONE NUMBER: S3 272 jedlows CONTACT PERSON: c.Iti, �2120 EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: lacyvt�cy/, Mg�n�-tnartt,�� A-5 INFORMATION I RECOMMENDATIONS: 'fMX)S.E ab�41y,.. Fire District: m, Je 0 P 60,1 Co la o -s, art. i` M, r D✓� 4) c. All 1-411 l 'flI Se a n�a f� Co,.cf 41.t4r-s Waste Transportation: Ll Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) 1Z Miscellaneous Corrosives �ry w„%o%% alp 1 ❑ NEW ❑ USED Cesspool cleaners �.c��-f"ics� Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) 1 Caulk/Grout/A/-ke,s,.fcs :L7 Swimming pool chlorine iS,► Leo Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's 10 Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables(ac--osol s) Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes I`I�c o rhMG�aQ Laundry soil &stain removers (including bleach) 64Q, 10K-s IKI Dhol 4 Spot removers &cleaning fluids I ` n I (dry cleaners) IV, RVIV 44&15 I." V1�i ardCo,�S J�I��f,al5 p� Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials TOWN OF BARNSTABLE BAR-W 4534 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager 911�4-d A P jP e) Address of Offender MV/MB Reg.# Village/State/Zip ` � Business Name ` t �o j, s �i/ ny� }- ,1r, V1yli� 7:3o , Qpm, on IZ/0 20 1,3 l — - Business Address 112'7 �/uri,t�n,, jt Signature "oYEriforcing Officer Village/State/Zip q,14 Y)46 , M 4 t)?G,01 �r # Location of Offense T- mA 0g4V1 11 .i 1 Enforcing Dept/Division Offense tAs1yd{— `_� 3�' •a,N1 a' ,R r�,,'a 1 "t ��(��-��a 1 � tklrl x °�. ��! / Cry,{ ariE- Facts Cale C �'gof<-< /09- ( . _ fj � This will serve only /as a warning. At/this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR_W 't Ordinance or Regulation WARNING NOTICE Name of Offender/Manager } 1 Al 0Z i ,) Address of Offender MV/MB Reg.# Village/State/Zip Business Name 'am/pm, on 20 E Business Address fi27r,,4} . i — �" Signature .of/Enforcing Officer Village/State/Zip �1,1 1 �104:6 , f Location of Offense `" , ,1 `f f ",� ►3Y' �� fig+at i � ` Enforcing Dept/Division Offense i I Y �� 3 i f.•k' ,7 `r S � t E y i i 'f 1 � /� .x �t i e �"' s 0, C; Facts i { (3 I This will serve only "as a warning. At'this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are. , attempts to gain voluntary compliance. Subsequent violations will result appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORDJREG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT.